1922189729 NPI number — MEDCOLOGY LLC

Table of content: NICOLE JO SMIGLIANI LPC, MA (NPI 1376303784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922189729 NPI number — MEDCOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDCOLOGY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922189729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22656
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73123-1656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-470-1884
Provider Business Mailing Address Fax Number:
405-470-1028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3431 S BOULEVARD ST
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-5475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-562-1870
Provider Business Practice Location Address Fax Number:
405-562-1871
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CATO
Authorized Official First Name:
T DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER ADMINISTRATOR
Authorized Official Telephone Number:
405-470-1884

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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